A statistic haunts me as I search for a new care home in preparation for mum’s final move. On average, residents of care homes get only two minutes of social interaction with staff a day.
While this statistic is based on a small sample of homes in England, I fear it sums up the quality of care in the UK. The randomised control study found that increasing interaction to 10 minutes a day improved residents’ wellbeing. Of course, 10 is better than two, but is 10 minutes enough?
Low expectations for vulnerable people
I welcome the study, and the associated programme, with its unique focus on improving wellbeing. But I wonder if it reflects the low expectations we have for some of the most vulnerable people in our society. According to Alzheimer’s Society, seven in 10 people living in care homes have dementia. They will normally be in the moderate to advanced stages of the disease, and their physical and emotional needs may be complex. They deserve better than this.
No option but to bring mum home
If left to her own devices, my mum soon becomes agitated or despondent. She wants to get home to see her parents or fears she has some responsibility beyond her abilities. If not supported appropriately her distress escalates to full blown meltdowns, as often happened in her previous care home.
The staff at mum’s home were kind and attentive, but they didn’t have adequate training in dementia care or any training in mental health issues. They were at a loss to help my mother.
After two and half years at the home, mum still didn’t settle. She often wished she was dead. So, after much personal anguish, I eventually decided to bring her home for a year. Apart from caring for her at home, I am using this time to develop a more effective care plan and find a better care home.
How to find the elusive good home
So how do you find a good home? Mum’s previous home was highly regarded, and I was initially very impressed. The setting, grounds and facilities were excellent. Most of the other families seemed entirely satisfied with the care provided. On top of this the quality of care had the thumbs up from the inspectors, Care Inspectorate Wales. In their last report they found, “people receive appropriate person-centred care to meet their individual physical and emotional needs”.
So, how do I look past outward appearances and positive reports to make the right choice this time? I have previously concluded the key is adequate training of staff and the quality of their interactions with residents. I still think that’s correct. But these critical elements depend on leadership. Management and policies determine how a care home recruits, trains, supports, manages and motivates their staff. If the home gets these things right, they are probably ticking other important boxes too. So now, I think the most critical question is ‘Does the care home have effective leadership?’
Does the care home have good leadership?
How do we find out? Helpfully, Care Inspectorate Wales and the inspectors for England, Scotland and Northern Ireland assess and report on ‘leadership’. That’s a start. The next thing is to meet with the home manager or senior carer and ask probing questions about staff recruitment, training and retention. See my suggested questions (PDF). You can find out a lot about management and the quality of care, by the responses to these questions. It’s also important to meet staff and see how motivated and engaged they are.
What specific dementia-care training do staff get?
Here, the Abertawe Bro Morgannwg Health University Board offers five days of comprehensive dementia-care training. It is informed by leaders in the field of dementia-care, people like Teepa Snow and her Postive Approach to Care. They offer the training free to all care homes in the area. Mum’s former care home preferred their own in-house training, which I believed was woefully inadequate. I raised the issue with the Head Office, but to no avail.
If a care home that I shortlist doesn’t take up the training offered by the health board, I will want very specific details on what they provide. It’s staggering that there are no minimum requirements for dementia-care training. The study, mentioned above, also found that, “out of 170 available training programmes for nursing home staff, only three are evidence-based – none of which improve quality of life.“
Observing interactions with residents
Apart from examining the inspector’s report and interviewing the manager and staff, I will sit in the care home lounge to witness first-hand the quality and quantity of interactions with residents.
All this may sound onerous, but getting the decision wrong costs a lot more than time and energy. It repeatedly broke my heart to see and hear about the distress and anguish my mother faced.